{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T04:10:43Z","timestamp":1781583043053,"version":"3.54.5"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Less Invasive Surfactant Administration (LISA) has been established for treating respiratory distress syndrome (RDS) in preterm infants, but the impact of pharmacological analgesia or video laryngoscopy on procedural success and safety remains unclear. We evaluated procedural success and adverse events of LISA performed according to a standardized protocol incorporating intravenous opioid analgesia and video laryngoscopy assistance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center, retrospective, observational study was conducted at a tertiary neonatal unit from September 2021 to August 2023. All live-born infants &amp;lt;32 weeks\u2019 gestation were screened. Exclusion criteria were parental objection to data use, missing primary outcome data, major congenital malformations, prenatal palliative care decisions, outborn transfered after 24\u2005h of life or already receiving invasive ventilation. The LISA protocol comprised the administration of intravenous fentanyl (1\u2005\u00b5g\/kg) 3\u20135\u2005min prior to video laryngoscopy, followed by delivery of Poractant alfa (100\u2013200\u2005mg\/kg) via a thin oral catheter. The primary endpoint was first-attempt success. Secondary endpoints comprised the frequency of procedure-related adverse events, including bradycardia (HR &amp;lt;80 bpm), desaturation (SpO\u2082\u2009&amp;lt;\u200980%), number of LISA attempts, arterial hypotension, and LISA failure, defined as intubation with subsequent mechanical ventilation within 72\u2005h.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 243 live-born infants, 63 were excluded from analysis. Of the remaining 180 infants 84 (47%) received LISA, 45 (25%) were intubated in the delivery room and 51 (28%) remained on non-invasive ventilation without surfactant. In the LISA cohort (median gestational age: 29\u2009+\u20093 weeks; mean birth weight: 1,176\u2005g), fentanyl was administered to 83\/84 patients (99%), and video laryngoscopy was used in 82\/84 patients (98%). First-attempt success was achieved in 52\/84 (62%) infants. Attending physicians had a significantly higher probability of first-attempt success than interns (OR 4.86, 95% CI 1.40\u201316.80,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013). Periprocedural bradycardia occurred in 6 infants (7%), desaturation in 65 infants (77%) and post-procedure hypotension in 6 infants (7%). LISA failure occurred in 14\/84 (17%) infants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study provides detailed data on the procedural quality of LISA when opioid analgesia and video laryngoscopy are used. This data may inform future trials investigating analgesia strategies, safety, and long-term outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fped.2025.1704163","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T06:23:30Z","timestamp":1761891810000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Procedural success and safety of a standardized less invasive surfactant administration protocol using fentanyl premedication and video laryngoscopy in preterm infants &lt;32 weeks\u2019 gestation"],"prefix":"10.3389","volume":"13","author":[{"given":"Mircea-Horia","family":"Popa-Todirenchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedikt","family":"Bubl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabian","family":"Keller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Busso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Jaisli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa Marie","family":"B\u00fcnte","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc-Alexander","family":"Oestreich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Kidszun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"F655","DOI":"10.1136\/archdischild-2018-316557","article-title":"Less invasive surfactant administration (LISA): chances and limitations","volume":"104","author":"Herting","year":"2019","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B2","doi-asserted-by":"publisher","first-page":"f5980","DOI":"10.1136\/bmj.f5980","article-title":"Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and 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